Eliminating lymphatic filariasis in the Pacific

NAGASAKI – In the late 1970s, Japan made history by becoming one of the first countries in the world to eliminate lymphatic filariasis (LF). Also known as elephantiasis, this disease causes painful swelling of the limbs, and in advanced stages permanent disability.

I want to tell the story of the Pacific Program to Eliminate Lymphatic Filariasis, called PacELF, for short. The achievements unfolding across 22 Pacific Island nations exemplify what the world should be doing on a greater scale to end LF.

I first learned about the unimaginable and unforgettable suffering of this disease as a young student in Tokyo. I was further exposed to its devastating impacts during my posts in Samoa and Vanuatu in the 1990s for the World Health Organization (WHO).

Today, hundreds of millions of people worldwide remain at risk for this entirely preventable disease, with about 120 million people already infected. Left untreated, LF debilitates and disfigures all those infected, leaving them unable to attend school or work. In addition to the heavy physical and economic repercussions, people are further weighed down by social stigma, leading to enormous mental suffering and social isolation.

Japan’s achievement in combating this pernicious disease was made possible because of close collaboration with affected communities, local government officials, doctors, nurses and other public health specialists. The program matched the people’s needs with the expertise of the government, academia and health agencies. Today, Japan is building on this proven model of success to help eliminate LF in the neighboring Pacific Island Countries (PICs).

Part of the wider Western Pacific region, these 22 island nations are geographically dispersed across the Pacific Ocean and represent diverse cultures and economic interests, but when it comes to the region’s effort to wipe out LF, they share common ground.

With hundreds of millions of people at risk worldwide, it’s going to take strong public-private sector partnerships, shared commitment and unwavering determination to win the fight against LF. To that end, it is encouraging that world leaders and experts — both from donor and endemic countries — are stepping up with their knowledge, voice and resources to combat LF and other neglected tropical diseases. For inspiration, we can look to the PICs.

The turning point, in the PICs, was the formation of the PacELF, with support from health ministers, the Secretariat of the Pacific Community, the WHO and other partners. I took part in the launch of this bold partnership in 1999 to help harness the collective energy of these countries and put it toward one shared mission. Through PacELF, countries carry out community-driven treatment campaigns, working in close collaboration with partners to sharpen logistical and technical aspects of their programs.

PacELF began at a critical moment, when LF had a firm grip on 16 of the 22 PICs. I visited Kiribati many years ago and met a former school teacher whose legs were permanently disfigured and swollen — a painful and life-long consequence that could have been prevented with treatment. He told me that his only wish was to “walk on his own.”

Our ability to counter this disease once it reaches that advanced stage remains very limited, making prevention absolutely vital. Successful prevention requires community participation at all levels.

Each PacELF country has full ownership of its large scale treatment campaigns. They follow global WHO guidelines, but have the flexibility to customize social mobilization activities to fit the local context.

An excellent example of how this can be done is in Samoa, where they teamed up with local rugby teams to draw attention to the importance of taking safe and effective pills, promoting greater compliance with mass drug administration and vector control efforts. Faith-based communities performed a similar role in American Samoa.

To bolster the impact of PacELF’s country-led treatment campaigns, public and private partners help coordinate drug procurement, supply, storage, treatment and community participation. They also share technical advice on topics like health education, surveillance and data management. Working in partnership with government, pharmaceutical and academic partners enables better coordination and greater coverage of treatment programs. Japan, a long-standing partner in this effort, adds a surge of energy and experience to PacELF, drawing upon the expertise acquired during its own elimination campaign.

More than 15 years after the launch of PacELF, LF is losing its hold on the region. To date, eight nations have reduced prevalence enough to stop large-scale drug treatment, and have surveillance activities in place to ensure they have eliminated transmission. Among them, Niue, Palau and Vanuatu are working with the WHO to be certified LF-free.

Though we should celebrate these successes, there are still challenges ahead. Today, Papua New Guinea accounts for 90 percent of the PacELF population that needs treatment. Challenges include daunting economic, technical, logistical and political difficulties; however, the situation is beginning to change with close community engagement, public awareness and focused LF treatment.

Other countries, such as New Caledonia, also have work to do, but are moving toward success through this collaborative approach.

I am proud that Japan has been a major contributor from the start by pioneering a model to eliminate LF —providing financial support, technical and operational advice that has extended across the Pacific. Japan, together with global partners, has an opportunity to make history again.

With country ownership and customized mobilization campaigns, complemented by technical support and coordination with partners, PacELF has shown the world what can be done. Having worked toward this goal for many years, it is astounding to see just how close we are to eliminating this disease as a public health threat.

Taking the final steps in the Pacific will help reduce the regional and global burden, removing barriers to economic growth and allowing endemic countries to pull themselves out of extreme poverty. The control and elimination of LF and other neglected tropical diseases is an achievable legacy, and one we can create with sustained resources and commitments over the coming years.

A scientist at the World Health Organization from 1992-2013, Kazuyo Ichimori is currently a visiting professor at Nagasaki University.